Healthcare Provider Details

I. General information

NPI: 1982792099
Provider Name (Legal Business Name): JVS REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10632 LITTLE PATUXENT PKWY SUITE 129
COLUMBIA MD
21044-3273
US

IV. Provider business mailing address

10632 LITTLE PATUXENT PKWY SUITE 129
COLUMBIA MD
21044-3273
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-0300
  • Fax: 410-740-0302
Mailing address:
  • Phone: 410-740-0300
  • Fax: 410-740-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK R SALLITT
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 410-740-0300